Mild anemia as a possible cause of false positive stress echocardiography in non-obstructive coronary artery disease: A pathophysiologic hypothesis

Patel, Brijesh; Assaad, Mahmoud; Tolia, Sunit; Bajwa, Muhammad; Zughaib, Marcel

doi:10.1016/j.ijcard.2015.10.167

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…CKD may cause hyperkinetic circulation, contributing to the damage to the vessel wall [ 61 ]. On the other hand, it may lead to false-positive results in noninvasive tests performed for the diagnosis of CAD [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

A Newly Defined CHA2DS2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation—A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography

Wojszel

Kuźma

Rogalska

et al. 2022

JCM

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Purpose: Atrial fibrillation (AF) can be a valuable indicator of non-obstructive coronary artery disease (CAD) among older patients indicated for elective coronary angiography (CAG). Appropriate stratification of AF patients is crucial for avoiding unnecessary complications. The objective of this study was to identify independent predictors that can allow diagnosing obstructive CAD in AF patients over 65 years who were indicated to undergo elective CAG. Patients and methods: This cross-sectional study included 452 (23.9%) AF patients over 65 years old who were directed to the Department of Invasive Cardiology at the Medical University of Bialystok for elective CAG during 2014–2016. The participants had CAD and were receiving optimal therapy (median age: 73 years, interquartile range: 69–77 years; 54.6% men). The prevalence and health correlates of obstructive CAD were determined, and a multivariate logistic regression model was generated with predictors (p < 0.1). Predictive performance was analyzed using a receiver-operating characteristic (ROC) curve analysis. Results: Stenosis (affecting ≥ 50% of the diameter of the left coronary artery stem or ≥70% of that of the other important epicardial vessels) was significant in 184 (40.7%) cases. Multivariate regression analysis revealed that only the male sex (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.14–2.84, p = 0.01) and the newly created CHA2DS2-VA score (OR: 3.96, 95% CI: 2.96–5.31, p < 0.001) significantly increased the chance of obstructive CAD, while controlling for chronic kidney disease and anemia. The ROC curve analysis indicated that the CHA2DS2-VA scale may be a useful screening tool for the diagnosis of obstructive CAD (area under the ROC curve: 0.79, 95% CI: 0.75–0.84, p < 0.001), with ≥4 being the optimal cutoff value. Conclusions: Our study has proven that several older AF patients who are advised to undergo elective CAG have nonobstructive CAD. The CHA2DS2-VA score can contribute to improving the selection of patients for invasive diagnosis of CAD, but further investigation is required.

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Section: Discussionmentioning

confidence: 99%

A Newly Defined CHA2DS2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation—A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography

Wojszel

Kuźma

Rogalska

et al. 2022

JCM

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“…Hyperkinetic circulation in persistent anemia may aggravate arterial wall damage, leading to atherosclerosis progression [ 31 ]. On the other hand, mild anemia could be a possible cause of false-positive stress echocardiography in nonobstructive CAD, which would indicate the possibility of its opposite effect [ 32 ]. In addition to anemia reducing the probability of the lack of significant findings in coronary angiography, the prevalence of anemia was higher in the stenosis + group than in the stenosis − group.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation is a predictor of nonobstructive coronary artery disease in elective angiography in old age: a cross-sectional study in Poland and Russia

et al. 2021

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Background Significant changes in the coronary vessels are not confirmed in a large proportion of patients undergoing cardiac catheterization. Aims The present study aimed to determine correlates and independent predictors of nonobstructive coronary artery disease (CAD) in older adults referred for elective coronary angiography. Methods A cross-sectional study was conducted involving 2,214 patients referred to two medical centers (in Poland and Russia) between 2014 and 2016 for elective coronary angiography due to exacerbated angina, despite undergoing optimal therapy for CAD. The median age was 72 years (IQR: 68–76), and 49.5% patients were women. Results Significant stenosis (defined as stenosis of 50% or more of the diameter of the left main coronary artery stem or stenosis of 70% or more of the diameter of the remaining major epicardial vessels) was diagnosed only in 1135 (51.3%) patients. Female sex (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.44–3.72; p < 0.001) and atrial fibrillation (OR, 1.87; 95% CI 1.45–2.40; p < 0.001) were the main independent predictors of nonobstructive CAD. Significantly lower ORs were observed for diabetes (OR, 0.75; 95% CI 0.59–0.95; p = 0.02), chronic kidney disease (OR, 0.76; 95% CI 0.61–0.96; p = 0.02), and anemia (OR, 0.69; 95% CI 0.50–0.95; p = 0.02) after controlling for age, chronic heart failure, BMI, and study center. Discussion and conclusions The results confirmed that nonobstructive CAD occurs in a high percentage of older patients referred for elective coronary angiography. This suggests the need to improve patient stratification for invasive diagnosis of CAD, especially for older women and patients with atrial fibrillation. Trial registration number and date of registration: NCT04537507, September 3, 2020.

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Impact of Anemia on Exercise and Pharmacologic Stress Echocardiography

Bird

Morant

Al-Souri

et al. 2020

Journal of the American Society of Echocardiography

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Mild anemia as a possible cause of false positive stress echocardiography in non-obstructive coronary artery disease: A pathophysiologic hypothesis

Cited by 3 publications

References 6 publications

A Newly Defined CHA2DS2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation—A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography

A Newly Defined CHA2DS2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation—A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography

Atrial fibrillation is a predictor of nonobstructive coronary artery disease in elective angiography in old age: a cross-sectional study in Poland and Russia

Impact of Anemia on Exercise and Pharmacologic Stress Echocardiography

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